Is it all about age? Clinical characteristics of Kawasaki disease in the extremely young: PeRA research group experience

ABSTRACT

Objectives

In the evaluation of children with Kawasaki disease (KD), the age of onset is important and complications may occur if the distinctive features are not assessed accordingly. The objective of the study is to define the clinical and laboratory presentations and treatment outcomes of KD in infants ≤6 months of age compared to those >6 months multicentrically.

Methods

This retrospective study reviewed the medical records of the patients diagnosed with KD and followed up between January 2009 and January 2019.

Results

A total of 204 KD patients were enrolled and grouped according to age as Group I (≤6 months, n = 31) and Group II (>6 months, n = 173). Except for cervical adenopathy (19.3% vs. 47.4%, p = 0.03), the major clinical manifestations of KD were similar between groups I and II. However, the frequency of incomplete and atypical KD was higher in Group I (38.7% vs. 24.8%, p = 0.04, 38.7% vs. 8.1% p < 0.001, respectively). Clinical features such as vomiting/diarrhea (19.3% vs. 1.1% p < 0.001), aseptic meningitis (19.3% vs. 2.3%, p = 0.001) were more common in Group I. Percentage of neutrophils (45.5 vs. 36, p = 0.004) and hemoglobin levels (8 vs. 10.5 gr/dL, p = 0.02) were statistically lower and platelet count (737,000 vs 400,000/mm³, p = 0.004) was statistically higher in group I. Coronary artery lesions (CALs) were more common in Group I (48% vs. 20%, p < 0.001). Harada and Kobayashi scores appear to be effective in predicting coronary artery lesions (CALs) and IVIG resistance in the entire cohort. There was no diagnostic delay in group I (5.5 vs 6.5 days, p = 0.88).

Conclusions

Since clinical presentations and laboratory features of KD may vary with age, and the frequency of atypical and incomplete presentations is high, awareness of KD in young children should be raised among pediatricians.

KEYWORDS:

• Coronary artery lesion
• infant
• kawasaki disease
• vasculitis

Acknowledgments

None stated.

Authors’ contributions

Nuray Aktay Ayaz FÇ, BS and NAA designed the form of the study. FÇ and NAA prepared the initial draft of the article. All authors contributed to data collection, analysis and interpretation of data, providing comments to the draft article and final approval of the article.

Availability of data and materials

The data underlying this article will be shared on reasonable request to the corresponding author.

Ethical statements

The study was approved by local ethics committee and was performed according to the tenets of the declaration of Helsinki (date:18.12.2019, number: B.10.1.TKH.4.34.H.GP.0.01/223). Because of the retrospective nature of the study, obtaining written informed consent from the patients was not required.

Declaration of funding

No funding was received for the production of this manuscript.

Disclosure of any financial/other conflicts of interest

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.